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Fig. 1 Contrastenhanced computed tomography of the transverse colon showing thickening of the intestinal wall in a 67-year-old woman who had presented with abdominal pain and hematochezia.

Fig. 2 On hospital day 4, colonoscopy of the transverse colon revealed a deep longitudinal ulcer with dark purple color change.

Fig. 3 Pathological examination of a biopsy specimen obtained from the lesion in the transverse colon showed necrosis and desquamation of the surface epithelium, along with severe neutrophil infiltration in the lamina propria (hematoxylin and eosin stain). Fig. 4 Follow-up endoscopy of the transverse colon on hospital day 16 showed that the lesion had completely disappeared.

A 67-year-old woman presented with abdominal pain and hematochezia. She had never used non-steroidal anti-inflammatory drugs, but had been started on amoxicillin, clarithromycin, and lansoprazole 3 days earlier as Helicobacter pylori eradication therapy. On admission, white blood cell count was 21 600/µL and C-reactive protein level was 2.8 mg/dL. Computed tomography showed thickening of the intestinal wall from the ascending to " Fig. 1). No occlusion transverse colon (● of the superior mesenteric artery was found. We prohibited ingestion and started an intravenous drip without antibiotic. Klebsiella oxytoca was detected in culture of a fecal sample taken on admission, and neg-

ative results were obtained for Clostridium difficile toxin. On hospital day 4, colonoscopy revealed a deep longitudinal ulcer in the colon with dark purple color " Fig. 2). Pathological examinachange (● tion of a biopsy specimen showed necrosis and desquamation of the surface epithelium, along with severe neutrophil in" Fig. 3). filtration in the lamina propria (● The patient gradually improved, and follow-up endoscopy was performed on hospital day 16. The lesion had completely " Fig. 4), together with her disappeared (● complaints and blood test abnormalities. Antibiotic-associated hemorrhagic colitis (AAHC) is a well-known complication after taking antibiotics, mainly penicillins, however, the underlying mechanism re-

mains unknown. Some reports have suggested K. oxytoca as the cause [1, 2], but this bacterium has not been consistently isolated [3]. Diffuse mucosal hemorrhage is described as a typical endoscopic finding of AAHC, whereas ulceration is uncommon [3]. Although a variety of histological changes have been reported in AAHC, few reports have described longitudinal ulceration. The major pathological findings seem to be intramucosal hemorrhage with generally little inflammatory cell infiltration [4, 5]. Endoscopy_UCTN_Code_CCL_1AD_2AJ Competing interests: None

Abe Koichiro et al. Antibiotic-associated hemorrhagic colitis with ischemic change … Endoscopy 2014; 46: E601–E602

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Antibiotic-associated hemorrhagic colitis with ischemic change

Cases and Techniques Library (CTL)

Koichiro Abe, Yu Kawashima, Hitoshi Aoyagi, Satoshi Kimura, Akari Isono, Tadahisa Ebato, Takatsugu Yamamoto, Hiroto Kita, Yasushi Kuyama Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan

References 1 Totani T. Acute hemorrhagic enteritis with Klebsiella oxytoca. Nihon Rinsho 1978; 36: 1308 – 1309 2 Högenauer C, Langner C, Beubler E et al. Klebsiella oxytoca as a causative organism of antibiotic-associated hemorrhagic colitis. NEJM 2006; 355: 2418 – 2426 3 Kishida T, Sato J, Fujimori S et al. An endoscopic study of antibiotic-associated hemorrhagic colitis. Nihon Ika Daigaku Zasshi 1992; 59: 450 – 456 4 Satake Y, Takahashi Y, Yamamura M et al. Endoscopic and histopathological differences between antibiotic-associated hemorrhagic colitis and ischemic colitis. Gastroenterol Endosc 1985; 27: 344 – 350 5 Sakurai Y, Tsuchiya H, Ikegami F et al. Acute right-sided hemorrhagic colitis associated with oral administration of ampicillin. Dig Dis Sci 1979; 24: 910 – 915

Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1390717 Endoscopy 2014; 46: E601–E602 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X

Corresponding author Koichiro Abe, MD Department of Internal Medicine Teikyo University School of Medicine 2-11-1 Kaga Itabashi-ku Tokyo 173-8606 Japan Fax: +81-3-53751308 [email protected]

Abe Koichiro et al. Antibiotic-associated hemorrhagic colitis with ischemic change … Endoscopy 2014; 46: E601–E602

This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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